AG Jepsen, DSS: Settlement Resolves Dispute, Provides
Reimbursement for Patients Billed for Substance Abuse Treatment
Patients who were inappropriately billed by Connecticut Behavioral Health Associates (CBHA) for opioid dependence detoxification using the drugs Suboxone or Subutex during a five-year period will receive a refund through a settlement agreement, Attorney General George Jepsen and Department of Social Services (DSS) Commissioner Roderick L. Bremby announced today.
State and federal laws require Connecticut Medical Assistance Program (CTMAP) providers to accept as payment-in-full the CTMAP payment for a covered service, meaning that treatment providers may not bill patients directly for the service. The agreement will provide up to $512,224 in refunds to about 400 patients enrolled in CTMAP who were directly billed by CBHA for services from October 2006 to September 2011. CBHA is a mental health services provider with offices in Stonington, New London and Norwich.
“This is fair and equitable resolution that ensures patients receive reimbursement for these treatment services,” said Attorney General Jepsen. “I credit CBHA for stepping up and working with my office and DSS to rectify the problem once they were alerted to the billing errors. I’m pleased that we were able to work with DSS and with CBHA to find a mutually agreeable solution that ultimately puts patients first.”
Commissioner Bremby said, “The true beneficiaries of this settlement will be individual patients who were improperly billed for the treatment services. Department of Social Services staff worked closely with the Attorney General’s Office to safeguard program integrity, and we also acknowledge the cooperation of the service provider through this process.”
In May 2011, DSS notified CBHA that approximately 400 patients had been treated with Suboxone or Subutex and may have been incorrectly billed directly for the treatment covered through CTMAP, which includes Medicaid. Under CTMAP, providers such as CBHA are required to bill DSS directly for covered services.
After DSS discovered the billing errors by the service provider, it alerted CBHA of the problem and directed CBHA to issue refunds to eligible patients. CBHA denied any wrongdoing, but voluntarily stopped directly billing patients for these services in September 2011 and has now agreed to pay the refunds directly to the patients.
Under the settlement, refunds will be issued to eligible patients in four quarterly groups over a nine-month period beginning 60 days after the agreement’s effective date. DSS will then reimburse CBHA with its standard fees for the services.
Assistant Attorneys General Gregory O’Connell and Michael Cole, chief of the Office of the Attorney General’s Antitrust and Government Program Fraud Department, assisted the Attorney General with this matter.
Office of the Attorney General:
Jaclyn M. Falkowski
Department of Social Services: